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Do Psychosocial Factors Affect Coronary Atherosclerosis Risk?


Am Fam Physician. 2006 Sep 15;74(6):1032-1034.

Studies have shown an association between coronary heart disease and depression, anger, anxiety, and stress; however, the reason for this association is unknown. Many biologic mechanisms have been suggested for the effects of psychosocial factors on the risk of coronary atherosclerosis. Diez Roux and colleagues conducted a cross-sectional study to examine the relationship between self-reported psychosocial factors and coronary calcium levels in adults without a history of cardiovascular disease.

Data were collected from the Multiethnic Study of Atherosclerosis (MESA), a longitudinal, multicenter study of risk factors for subclinical atherosclerosis. The study population consisted of 6,814 white, black, Hispanic, and Chinese adults 45 to 84 years of age who were recruited from six U.S. communities. Participants completed a baseline questionnaire to record sociodemographic data, and they received physical examinations and laboratory testing for established cardiovascular risk factors (e.g., hypertension, hyperlipidemia, diabetes). Participants had chest computed tomography (CT) to measure coronary calcium levels. A cardiologist, who was blinded to participants’ characteristics and clinical histories, interpreted the CT scans. Participants completed standardized questionnaires to assess levels of depression, anger, anxiety, and chronic stress burden. For each of the psychosocial factors, patients were divided into three or four groups based on their questionnaire scores.

Although race and ethnicity were not consistently associated with psychosocial factors, current smokers reported higher levels of all factors. Women and participants with an annual income less than $25,000 reported higher levels of anxiety, depression, and chronic stress burden. After adjustment for socioeconomic status and cardiovascular risk factors, there was no relationship between the presence or degree of coronary calcification and any psychosocial factor.

The authors conclude that depression, anger, anxiety, and stress are not associated with coronary calcification in asymptomatic adults, implying that these psychosocial factors do not contribute to subclinical atherosclerosis. The authors concede that a significant limitation of this study is its use of one-time measurements rather than assessments of long-term exposure to psychosocial factors.

Diez Roux AV, et al. Psychosocial factors and coronary calcium in adults without clinical cardiovascular disease. Ann Intern Med. June 6, 2006;144:822–31.

editor’s note: Physicians already know that depression, anger, anxiety, and chronic stress are unhealthy. It is less certain if these factors are bad for the heart. An editorialist in the same issue of the journal argues that the study by Diez Roux and colleagues does not disprove a link between psychosocial factors and coronary events, but suggests that a different mechanism is involved.1 Because we are unable to predict which low-risk patients will experience coronary events, family physicians should identify and treat psychosocial factors in the hope that what is good for the mind also is good for the heart.—k.w.l.


1. Whooley MA. Mind your heart [Editorial]. Ann Intern Med. 2006;144:858–60.



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